Development of
Professionalism Assessment Scale for Nurse Educator
Bharat Pareek1,
Kiran Batra2, Raman Kalia3
1Vice Principal,
Saraswati Nursing Institute Punjab and PhD Scholar
National Consortium for PhD in Nursing, New Delhi
2Principal,
Silver Oaks College of Nursing Abhipur Mohali, Punjab
3Principal, Saraswati Nursing Institute Kurali
Ropar, Punjab
*Corresponding Author Email: pareekbharat10@gmail.com
ABSTRACT:
Nursing profession began with a genuine desire to serve and care for
others, combined with a sense of compassion and commitment. Nurse Educator play
a vital role in the health care system globally. The professionalism and
performance of Nurse Educators, link closely to the productivity and quality of
services they provide. It is important to identify factors influencing
professionalism of Nurse Educators if the quality of education in the organizations
to be improved. A non experimental methodological study was carried out to develop professionalism
assessment scale for Nurse Educator. The conceptual framework used to guide this study was
Healthy Work Environments for Nurses –
Components, Factors and Outcomes developed by Registered Nurses’ Association of
Ontario in 2007. Scale was prepared under five stages i;e conceptualization and item generation, preliminary
evaluation, administration to development sample, analysis of scale development
data and scale refinement and validation. Psychometric qualities of the scale
such as validity (content, convergent, divergent and know group) and
reliability (internal consistency and stability) was determined at preliminary
level. After preliminary evaluation, scale was introduced to 30 Nurse Educators
of various nursing institutions using judgmental sampling technique. SPSS was
used for statistical analysis. Factor analysis approach was used to determine
construct validity of the scale. Principal component analysis (extraction
method) was used to determine total variance of scale items which
resulted into extraction of nine components
(domains of professionalism) of scale based on Eigen value =1. Further Varimax with Kaiser Normalization (Rotation Method) was performed to determine scale items correlation
and all 34 scale’s items were positively correlated and retained in the scale
(Based on factor loading of 0.4). Reliability (internal consistency) of scale
was determined. Cronbach's Alpha is used to determine internal consistency (p=.926)
where as test retest method was used to determine scale’s stability (p=.89) and scale found to be reliable. Domain wise
correlation were also calculated which indicates high internal consistency
among all nine domains of scale. Finally scale user’s norms were established.
INTRODUCTION:
“Our lives begin
to end the day we become silent about things that matter.”
Martin Luther King, Jr.
Professionalism in nursing
began with our early roots with Florence Nightingale. She was an inventor, a
visionary, a missionary and she delivered all with a commitment to passion and
love1.Wilkinson et
al. in 2009 organized professional attitudes and behaviors into the five
clusters which are adherence to ethical practice principles, effective interactions with patients and
people important to those patients, effective interactions with others working in the healthcare system,
reliability, commitment to autonomous maintenance and
continuous improvement of competence2
Professionalism attributes
include knowledge, spirit of inquiry, accountability, autonomy, advocacy,
innovation and visionary, collaboration and collegiality, and ethics3
In order to emphasize
professionalism within nursing and among Nurse
Educators, each Nurse Educator
needs to understand the opportunities, responsibilities and concerns that are
integral to the nursing profession4
Professionalism cannot be
compromised at any level but the increasing expectation in the presence of
decreasing resources confronting medical and nursing profession, particularly
in the academic environment.5
The high level of professionalism among Nurse Educators
is essential to fulfill the profession’s obligations to society6.
OBJECTIVE:
1.
To
Develop Professionalism Assessment Scale for Nurse
Educator
MATERIAL AND METHODS:
A non
experimental methodological study was carried out to develop professionalism assessment scale for Nurse Educators.
Scale was prepared under five steps which are as follow
Step 1:-
Conceptualization and Item
Generation:-
for the development of the professionalism
assessment scale, operational definition of nursing professionalism was
determined on basis of literature review, existing scales, expert’s opinions,
focus group discussions and peer discussions. A total 72 items were pooled and
categorized under eight components of professionalism based on this. Domains of
professionalism for the scale includes Knowledge, Spirit of Inquiry,
Accountability and Autonomy, Advocacy, Innovation and visionary, Ethics and
Values and Citizenship and Professional engagement.
Step 2:- Preliminary
Evaluation: -
Preliminary
scale along with content validity index was submitted to panel of experts from
the field of nursing and management to determine content validity. Content
validity index for each item (CVI-I) was calculated based on experts agreements
of at least 70% for any given items where as content validity index for scale
(CVI-S) was determined. Convergent validity of the scale was determined by
using mono trait mono method where study scale along with another similar scale
developed by registered nurses association of Ontario (RNAO). Both the scales
were introduced to the group of Nurse Educators and score correlation of both
scales determines high convergent validity (0.91). Divergent validity was
determined by introducing study scale along with occupational burnout inventory
to the group of Nurse Educators and score observed negatively correlated
(-0.48). Known group validity of the scale was determine by introducing study
scale to the two groups of Nurse Educators among them one group of educators
are known to be highly professional. Obtained scores were clearly discriminate
between two groups of nursing teachers which determine discriminating power of
the scale. A total of 34 items retained in the scale for further analysis.
Reliability
(internal consistency) of scale was determined at preliminary level and after
data collection from development sample. Cronbach's Alpha (split
half method) is
used to determine internal consistency (p=.926). Test retest method was used to determine
scale’s stability by introducing professionalism assessment scale to the same
participants twice with interval of two weeks. Mean, SD of two scores (before and
after) were compared to rule out probability of pre-test sensitization.
Positive correlation between scores shows tool’s stability (p=.89). Domain wise correlation were also calculated which
indicates high internal consistency among all nine domains of scale.
Scale Item responses were
determined. A continuum of positive and negative response was designed for each
statement
in the scale which is given below.
+3
Always
-1 Once in a great while
+2
Usually
-2 Rarely
+1 Sometimes
-3 Never
Demographic
data sheets of Nurse Educators and institution they work for were also
developed.
Step 3:- Administration to
development sample:-
Professionalism
assessment scale along with the study objectives were presented before the
institutional ethical committee of Saraswati nursing
institute Kurali. Ethical clearance to collect data
form developmental sample (Nurse Educators) was obtained. A total of 30 Nurse
Educators working with various government and private nursing institution in
Punjab and Chandigarh were selected based on sample inclusion criteria by using
judgmental sampling technique. Anonymity of Study participants were assured by
assigning code for respondents and their institutions. All the participants
were informed that their participation is completely voluntary. Data was
collected in the month of July and August 2015. Professionalism assessment
scale along with demographic data sheet was introduced to the study
participants. Data were organized into master data sheet.
Step 4:- Analysis of scale
development data:-
SPSS 1.6
version was used to analyze data collected from development sample under
following steps
A.
Basic Item Analysis:
Inter items as
well as inter domains correlation of professionalism assessment scale was
assessed by computing cronbach’s alpha and all the 34
items and eight domains of the scale were observed positively correlated
(correlation ranging between 0.73 to 0.91).
Reliability of scale was computed and scale found to be highly reliable (P=.925) therefore all the scale
items were included for exploratory factor analysis (Table 1 and 2)
B.
Principal component
analysis (Factor Extraction):-
Extraction method was used to determine total Variance of scale items on the basis that individual variance of each scale item
was determined and nine components (domains of professionalism)
of scale were extracted (Eigen values =1) (Table
3)
Table 1:- Inter items
Correlation Matrix of professionalism assessment scale
|
Items |
Initial |
Extraction |
Items |
Initial |
Extraction |
|
q1 |
1.000 |
0.911 |
q18 |
1.000 |
0.874 |
|
q2 |
1.000 |
0.767 |
q19 |
1.000 |
0.880 |
|
q3 |
1.000 |
0.818 |
q20 |
1.000 |
0.864 |
|
q4 |
1.000 |
0.800 |
q21 |
1.000 |
0.813 |
|
q5 |
1.000 |
0.838 |
q22 |
1.000 |
0.833 |
|
q6 |
1.000 |
0.875 |
q23 |
1.000 |
0.949 |
|
q7 |
1.000 |
0.770 |
q24 |
1.000 |
0.917 |
|
q8 |
1.000 |
0.917 |
q25 |
1.000 |
0.818 |
|
q9 |
1.000 |
0.883 |
q26 |
1.000 |
0.718 |
|
q10 |
1.000 |
0.829 |
q27 |
1.000 |
0.898 |
|
q11 |
1.000 |
0.763 |
q28 |
1.000 |
0.870 |
|
q12 |
1.000 |
0.773 |
q29 |
1.000 |
0.830 |
|
q13 |
1.000 |
0.884 |
q30 |
1.000 |
0.820 |
|
q14 |
1.000 |
0.725 |
q31 |
1.000 |
0.907 |
|
q15 |
1.000 |
0.750 |
q32 |
1.000 |
0.734 |
|
q16 |
1.000 |
0.740 |
q33 |
1.000 |
0.802 |
|
q17 |
1.000 |
0.899 |
q34 |
1.000 |
0.801 |
Table 2:- Inter domains
Correlation Matrix of professionalism assessment scale
|
Domains |
Co-relation
|
Knowledge |
Spirit of
inquiry |
Accountability
|
Advocacy |
Innovation |
Collegiality
and collaboration |
Ethics
and values |
Citizenship
and Prof. engagement |
|
Knowledge |
Pearson Correlation |
1 |
0.940(**) |
0.730(**) |
0.535(**) |
0.504(**) |
0.433(*) |
0.454(*) |
0.407(*) |
|
Spirit of
inquiry |
Pearson Correlation |
0.940(**) |
1 |
0.742(**) |
0.471(**) |
0.441(*) |
0.379(*) |
0.376(*) |
0.378(*) |
|
Account-ability |
Pearson Correlation |
0.730(**) |
0.742(**) |
1 |
0.499(**) |
0.649(**) |
0.356 |
0.686(**) |
0.400(*) |
|
Advocacy |
Pearson Correlation |
0.535(**) |
0.471(**) |
0.499(**) |
1 |
0.650(**) |
0.614(**) |
0.517(**) |
0.647(**) |
|
Innovation |
Pearson Correlation |
0.504(**) |
0.441(*) |
0.649(**) |
0.650(**) |
1 |
0.642(**) |
0.767(**) |
0.526(**) |
|
Collegiality
and collaboration |
Pearson Correlation |
0.433(*) |
0.379(*) |
0.356 |
0.614(**) |
0.642(**) |
1 |
0.625(**) |
0.616(**) |
|
Ethics
and values |
Pearson Correlation |
0.454(*) |
0.376(*) |
0.686(**) |
0.517(**) |
0.767(**) |
0.625(**) |
1 |
0.597(**) |
|
Citizenship
and Prof. engagement |
Pearson Correlation |
0.407(*) |
0.378(*) |
0.400(*) |
0.647(**) |
0.526(**) |
0.616(**) |
0.597(**) |
1 |
|
Overall scale reliability (internal consistency) 0.925 (Cronbach’s
Alpha) for 34 items |
|||||||||
**Correlation
is significant at the 0.01 level (2-tailed).
*
Correlation is significant at the 0.05 level (2-tailed)
Table 3:- Extraction Method: Principal
Component Analysis
|
Component |
Initial
Eigen values |
Extraction
Sums of Squared Loadings |
Rotation
Sums of Squared Loadings |
||||||
|
Total |
% of
Variance |
Cumulative
% |
Total |
% of
Variance |
Cumulative
% |
Total |
% of
Variance |
Cumulative
% |
|
|
1 |
11.636 |
34.224 |
34.224 |
11.636 |
34.224 |
34.224 |
5.889 |
17.320 |
17.320 |
|
2 |
3.457 |
10.168 |
44.392 |
3.457 |
10.168 |
44.392 |
4.250 |
12.501 |
29.821 |
|
3 |
2.931 |
8.621 |
53.013 |
2.931 |
8.621 |
53.013 |
3.170 |
9.323 |
39.144 |
|
4 |
2.677 |
7.872 |
60.886 |
2.677 |
7.872 |
60.886 |
3.085 |
9.074 |
48.219 |
|
5 |
2.039 |
5.996 |
66.882 |
2.039 |
5.996 |
66.882 |
3.014 |
8.865 |
57.084 |
|
6 |
1.623 |
4.774 |
71.655 |
1.623 |
4.774 |
71.655 |
2.577 |
7.581 |
64.665 |
|
7 |
1.461 |
4.297 |
75.952 |
1.461 |
4.297 |
75.952 |
2.473 |
7.274 |
71.939 |
|
8 |
1.300 |
3.824 |
79.777 |
1.300 |
3.824 |
79.777 |
2.149 |
6.322 |
78.261 |
|
9 |
1.146 |
3.371 |
83.148 |
1.146 |
3.371 |
83.148 |
1.662 |
4.887 |
83.148 |
C.
Principal component
analysis (Factor rotation):-
Varimax with
Kaiser Normalization (Rotation Method) was
performed to determine scale items correlation and all 34 items were retained
for the scale (Based on factor loading of ˃0.4). Each item is examined
based on its theoretical importance and factor loading for both rotated as well
as un-rotated correlation matrix. All 34 items were retained in the scale. on
the basis of orthogonal rotation scale’s components were restructured into nine
components which were eight earlier and scale’s items were also rearranged based on their correlation with
particular component
Step 5:- Scale refinement and
validation:-
Revision of each retained scale’s item was
performed. All the reorganized scale’s
items under nine domains of professionalism were re examined under theoretical
perspective and validation study was conducted. Refined scale along with
content validity index was submitted to the panel of experts from the field of
nursing and content validity was determined by computing content validity
index. Scale found to be valid and no changes were made in the scale. User
norms were established and final professionalism assessment scale produced.
DISCUSSION:
As today’s heath care model moves toward more
streamlined and corporate industrialism, it is our responsibility to ensure the
integrity and maintain professionalism. The erosion of professional values not
only creates a climate of animosity, but reverberates negatively to impact the
development of nursing student’s professionalism7.
Present study used rigorous non-experimental
methodological design to develop professionalism assessment scale for Nurse Educator.
The conceptual framework used to guide this study was Healthy Work Environments for Nurses – Components,
Factors and Outcomes developed by Registered Nurses’ Association of Ontario in
2007. The Professionalism
in Nursing Best Practice (RNAO developed) Guideline, miller’s model of
professionalism and exiting literature review was used to develop construct of
professionalism. Different dimensions of professionalism’s construct were explored
which resulted in extraction of eight domains of professionalism assessment
scale. Items were explored and organized under these domains. Content,
construct validity and reliability (internal consistency and stability) of the
preliminary scale were determined.
Domains
of professionalism for this scale includes Knowledge, Spirit of Inquiry,
Accountability and Autonomy, Advocacy, Innovation and visionary, Ethics and
Values and Citizenship and Professional engagement; many of these domains were
also describe by Bryan-Brown
in 2003 based on a survey where nurses were asked to expressed their view on what professionalism was to them. The top
eight responses of surveys were included Knowledge, Respect for others,
Competence, Integrity, Appearance, Positive Attitude, Teamwork and Compassion8,
Wilkinson
et al. (2009) organized professional behavior into the five clusters which
includes Adherence to ethical practice principles, Effective interactions,
Collaboration, Reliability and Commitment to autonomous maintenance and
continuous improvement of competence. All these components of professional
behaviors were considered while constructing the operational definition of
professionalism for the scale2
Flexner in 1915 describe the dependent variables
(criteria) of professionalism, these variables were used to determine
psychometric qualities of the study’s scale such as convergent, divergent
validity and discriminating power. This variable includes enrolment in a formal
program of study, subscription of professional journals, attendance at non-
formal educational programs, number of authored publications, Membership in
professional organization and employment in prepared area, as these seemed to
reflect the criteria of professionalism. All these variable were also included
in demographic section of the scale9
Polit and Beck describe five steps of scale development
which includes conceptualization and item
generation, preliminary evaluation, administration to development sample,
analysis of scale development data and scale refinement and validation present
study used all these steps to develop
professionalism assessment scale for Nurse Educator.10
Polit and Beck suggested that Reliability
coefficient greater than .70 and above generally considered adequate, however
measures greater than .80 are preferred for a newly developed scale. In present
study reliability of the scale was .92 which shows high reliability of the
scale.10
LIMITATIONS:
1. Criterion validity (predictive and
concurrent) were not determined
2. Sample size of development sample was small
3. Efficiency of the scale was not determined
4.
ACKNOWLEDGEMENTS:
I
owe my immense and long standing gratitude to all the participants of the
study, without their co-operation and participation it would have been impossible
to conduct the study. My sincere thanks to all those who assisted me,
directly or indirectly in the successful completion of this study
CONFLICT
OF INTEREST:-
The study entitled
Development of Professionalism Assessment Scale for Nurse Educator is a bonafide research
work of Mr. Bharat Pareek, Vice Principal, Saraswati nursing institute Punjab and PhD Scholar National
Consortium for PhD in Nursing New Delhi.
Authors do not have any relationships/ condition/ circumstances that
present a potential conflict of interest
SOURCE OF FUNDING:
The study entitled
Development of Professionalism Assessment Scale for Nurse Educator is the self funded research work of Mr. Bharat Pareek .
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Published Wolters Kluwer.
Ed 9th
Received on 02.12.2015 Modified on 21.03.2016
Accepted on 28.04.2016 ©
A&V Publications all right reserved
Asian J. Nur. Edu. and Research.2016;
6(4): 506-510.
DOI: 10.5958/2349-2996.2016.00095.1